Ethnicity, socioeconomic status, income inequality, and colorectal cancer outcomes: evidence from the 4C2 collaboration

Anderson-Mellies, Amy; Borrayo, Evelinn A.; Doherty, Jennifer A.; Escontrías, Omar A.; Garcia, David O.; Mishra, Shiraz I.; Sussman, Andrew L.; Thomson, Cynthia A.; Wetter, David W.; Cook, Linda S.

doi:10.1007/s10552-021-01547-6

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…There is mixed evidence about the relationship between income and cancer outcomes. In line with our ndings, the results of a study by Bradley et al [45] disclosed that living in areas with high-income inequality was directly related to mortality. Dos Santos Figueiredo and Adami [46] determined that income inequality is positively associated with increased breast cancer mortality in Brazil.…”

Section: Discussionsupporting

confidence: 92%

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces

Ahadinezhad

Maleki

Amerzadeh

et al. 2022

Preprint

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Background: Cancer is the second important cause of death worldwide. Cancer is one of the top health priorities in Iran. We aimed to study the socio-economic inequality of cancer incidence in Iran provinces. Methods: We conducted this cross-sectional study using provincial data. We obtained the required data from the statistical yearbook report, the Statistics Center Report and the National Cancer Registration Program Report of Iran’s Ministry of Health and Medical Education (MoHME) for 2018. Socio-economic inequality of cancer incidence was analyzed by estimating the concentration index and extracting the concentration curve. Statistical analyzes were performed using STATA 14. Results: Our findings revealed that cancer incidence was unequally distributed in terms of the socio-economic status in Iranian provinces. Cancer incidence is slightly concentrated in the provinces with higher than average literacy, per capita income and insurance coverage and household size below average. The concentration of cancer incidence has been to the detriment of the provinces that have a slightly better ranking in terms of the socio-economic index. The employment rate did not significantly affect cancer's distribution burden.Conclusion: We recommend policymakers facilitate early cancer detection by providing insurance coverage for screening services, payment exemptions, and public awareness.

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Section: Discussionsupporting

confidence: 92%

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces

Ahadinezhad

Maleki

Amerzadeh

et al. 2022

Preprint

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“…On the other hand, in terms of baseline characteristics, our cohort reflects the average population. However, because our results suggest an effect of educational status on the distribution of risk for advanced colorectal neoplasia, congruent with the prior literature, specific strategies to increase the participation rates of socioeconomic classes appear worth considering [23]. Also consistent with prior literature, we found a sitespecific effect of educational status on rates of advanced colorectal neoplasia [16,18].…”

Section: Discussionsupporting

confidence: 90%

The association between educational status and colorectal neoplasia: results from a screening cohort

Wernly

Semmler

Schaffler-Schaden

et al. 2023

Int J Colorectal Dis

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Introduction Educational status is used as a proxy for socioeconomic status. While lower levels of education are generally associated with poorer health, the data on the relationship between educational status and colorectal neoplasia is heterogenous. The aim of our study was to examine this relationship and to adjust the association between educational status and colorectal neoplasia for other health parameters. Methods We included 5977 participants undergoing a screening colonoscopy in Austria. We split the cohort into patients with lower (n = 2156), medium (n = 2933), and higher (n = 459) educational status. Multivariable multilevel logistic regression models were fitted to evaluate the association between educational status and the occurrence of any or advanced colorectal neoplasia. We adjusted for age, sex, metabolic syndrome, family history, physical activity, alcohol consumption, and smoking status. Results We found that the rates of any neoplasia (32%) were similar between the educational strata. However, patients with higher (10%) educational status evidenced significantly higher rates of advanced colorectal neoplasia compared to medium (8%) and lower (7%) education. This association remained statistically significant after multivariable adjustment. The difference was entirely driven by neoplasia in the proximal colon. Conclusion Our study found that higher educational status was associated with a higher prevalence of advanced colorectal neoplasia compared to medium and lower educational status. This finding remained significant even after adjusting for other health parameters. Further research is needed to understand the underlying reasons for the observed difference, especially with regard to the specific anatomical distribution of the observed difference.

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“…In 2015, the mortality attributed to these five types of cancer accounted for about three-quarters of all cancer mortality (5). In addition, 16.6% of the total disease burden (measured in DALYs) were attributed to cancer in China (8). Meanwhile, studies have found that cancer patients often bear considerable medical expenditure.…”

Section: Introductionmentioning

confidence: 99%

“…The inequality in health has been a major priority of the health system globally (15). Several studies have contributed an extensive amount of research on the many different dimensions of cancer outcome inequality (16)(17)(18)(19), including reporting gradients in cancer incidence, mortality, and survival were associated with deprivation and lower socioeconomic status. However, socioeconomic inequalities in health care use or behavior among cancer patients remain largely unexplored, although this type of inequality has also been observed in some high-income countries, such as South Korea, Australia, and England (20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study

Zhang

Chen

et al. 2022

Front. Public Health

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BackgroundCancer is a major public health problem worldwide and the leading cause of death in China, with increasing incidence and mortality rates. This study sought to assess socioeconomic-related inequalities in health care use among cancer patients in China and to analyze factors associated with this disparity.MethodsThis study used data collected for the China Health and Retirement Longitudinal Study in 2018. Patients who reported having cancer were included. The annual per capita household expenditure was classified into five groups by the quintile method. We calculated the distribution of actual, need-predicted, and need-standardized health care use across different socioeconomic groups among patients with cancer. The concentration index (CI) was used to evaluate inequalities in health care use. Influencing factors of inequalities were measured with the decomposition method.ResultsA total of 392 people diagnosed with cancer were included in this study. The proportion of cancer patients who utilized outpatient and inpatient services was 23.47% and 40.82%, respectively, and the CIs for actual outpatient and inpatient service use were 0.1419 and 0.1960. The standardized CIs (CI for outpatient visits = 0.1549; CI for inpatient services = 0.1802) were also both positive, indicating that affluent cancer patients used more health services. The annual per capita household expenditure was the greatest factor favoring the better-off, which contributed as much as 78.99% and 83.92% to the inequality in outpatient and inpatient services use, followed by high school education (26.49% for outpatient services) and living in a rural village (34.53% for inpatient services). Urban Employee Basic Medical Insurance exacerbated the inequality in inpatient services (21.97%) while having a negative impact on outpatient visits (−22.19%).ConclusionsThere is a pro-rich inequality in outpatient and inpatient services use among cancer patients in China. A lower socioeconomic status is negatively associated with cancer care use. Hence, more targeted financial protection for poor people would relieve cancer patients of the burden caused by the high cost of cancer care.

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Ethnicity, socioeconomic status, income inequality, and colorectal cancer outcomes: evidence from the 4C2 collaboration

Cited by 7 publications

References 10 publications

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces

The association between educational status and colorectal neoplasia: results from a screening cohort

Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study

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